| NPI | 1952992455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI LEE Senior Director 888-978-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2022-03-14 |